Being a hospitalist sucks, and I'm quitting

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Heck, I’m onc & generally considered to have one of the most compliant and pleasant pts, at least according to anecdotes and opinions from my med school classmates and co-residents who chose other specialties. Still, it’s not rare to encounter such jerks. And the occasional case of “daughter-from-California” syndrome.
 
Mehena said:
Heck, I’m onc & generally considered to have one of the most compliant and pleasant pts, at least according to anecdotes and opinions from my med school classmates and co-residents who chose other specialties. Still, it’s not rare to encounter such jerks. And the occasional case of “daughter-from-California” syndrome.
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What is that?
 
gutonc said:
I've never heard of this, but it took me less than half a second to recognize her/him and be like "oh yeah...that f***** b****".
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An even worse variant of this is “daughter/son from Colorado, who also happens to be an NP/PA/radiology tech/phlebotomist/whatever other uninformed medical professional”. Especially if daughter/son is a midlevel. I have a couple of these situations right now…I have visits with the patient and then a few days later get lengthy MyChart messages from daughter NP, questioning everything I’ve done and making it sound like I’m completely irresponsible and incompetent. However, daughter NP never seems to have time to join the pt at the visit, where all of their concerns could be addressed…and the pt themselves never wants all the interventions daughter NP insists they should have…
 
dozitgetchahi said:
An even worse variant of this is “daughter/son from Colorado, who also happens to be an NP/PA/radiology tech/phlebotomist/whatever other uninformed medical professional”. Especially if daughter/son is a midlevel. I have a couple of these situations right now…I have visits with the patient and then a few days later get lengthy MyChart messages from daughter NP, questioning everything I’ve done and making it sound like I’m completely irresponsible and incompetent. However, daughter NP never seems to have time to join the pt at the visit, where all of their concerns could be addressed…and the pt themselves never wants all the interventions daughter NP insists they should have…
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Epic smart phrase the forwards the message to your nurse saying "needs appointment".
 
VA Hopeful Dr said:
Epic smart phrase the forwards the message to your nurse saying "needs appointment".
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Oh I do. And then pt comes back for an appointment, minus daughter NP, and agrees to a tx plan which daughter NP again tries to question afterwards. Wash rinse repeat.

Lately I’ve stopped caring about it…daughter NP isn’t the patient at the end of the day anyway.
 
dozitgetchahi said:
Oh I do. And then pt comes back for an appointment, minus daughter NP, and agrees to a tx plan which daughter NP again tries to question afterwards. Wash rinse repeat.

Lately I’ve stopped caring about it…daughter NP isn’t the patient at the end of the day anyway.
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Why can daughter NP send messages to you in MyChart? But I probably know the answer, she bulldozed mom into giving her the login info 🙁
 
My favorite is when that son/daughter becomes proxy decision-maker and then ignores all the documented prior express wishes of the patient, and while everyone dithers about unplugging the patient, the patient recovers just enough to be a human vegetable just like they always wanted, and sent to SNF. Although that's not as bad as when this happens and the patient is still able to experience some suffering rather than passing peacefully as they wanted.

It has very real consequences we have to just sit by and watch. That's the whole point of a physician being burnt out morally. Many of us have adjusted to some of this. But it's real and it is something to cope with. I wonder about the folks that deep down on some level don't find it upsetting in the slightest. I've met those docs and they scare me a little.
 
wysdoc said:
Why can daughter NP send messages to you in MyChart? But I probably know the answer, she bulldozed mom into giving her the login info 🙁
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More proof we've given people too much leeway. As physicians (well maybe me less so and others in fields like rads and derm) are compassionate, unlike other fields, but we need to take a page out of other fields or else we will continue to get walked on. Anytime you ask a lawyer or financial advisor a question and take their time you are billed for it! Now we answer people as if we are call centers for verizon
 
Crayola227 said:
My favorite is when that son/daughter becomes proxy decision-maker and then ignores all the documented prior express wishes of the patient, and while everyone dithers about unplugging the patient, the patient recovers just enough to be a human vegetable just like they always wanted, and sent to SNF. Although that's not as bad as when this happens and the patient is still able to experience some suffering rather than passing peacefully as they wanted.

It has very real consequences we have to just sit by and watch. That's the whole point of a physician being burnt out morally. Many of us have adjusted to some of this. But it's real and it is something to cope with. I wonder about the folks that deep down on some level don't find it upsetting in the slightest. I've met those docs and they scare me a little.
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Time to start 3 additional pressors that cost 50k a pop STAT!
 
wysdoc said:
Why can daughter NP send messages to you in MyChart? But I probably know the answer, she bulldozed mom into giving her the login info 🙁
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In MyChart, patients can designate other people to have access to their chart. This is more of a thing in peds - where noncustodial mother and father may have separate access to MyChart for their kid etc - but it happens with adults also, especially when someone else has healthcare power of attorney. It absolutely makes sense in power of attorney situations, but more recently I’ve seen some pts just give multiple other people MyChart access, which leads to “daughter NP” situations as described above. It’s stupid, and lately I’ve just stopped answering these types of messages and telling these other peripheral people that they need to be present at the appointment if they have issues that they need to have addressed. I think it’s a bit insane to have multiple “side conversations” with other random people regarding a pts care, when the pt isn’t even present (and these other random people don’t have POA).
 
Not a doctor but, clearly some doctors still make mistakes and patients got no one but their families to advocate for them at times. It is hard to trust a doctor who told us to not worry when my cousin’s hemoglobin kept dropping after a c-section from 9 down to 7.3, she had a fever of 39, extreme swelling, and sustained HR in the 130s at 25 years old. He said all was due to inflammation for the time she was laboring for. He was not doing cultures until the next day, was not adding a broader spectrum abx, and was only giving her an iron infusion 15 hrs after the hb result of 7.3. Im not sorry if we had to be annoying to call somebody else’s attention.
It so happens she had a hematoma on her uterus and bleeding into it.
We did trust the infectious disease doc and the surgery team who finally did their jobs. But what if we hadn’t been annoying to that obstetrician?
Unfortunately, they set up the reputation for others. Yea it is not fair. But lots of people did die during Covid. And the majority of the population do not have medical knowledge and struggle to differentiate from a doctor who’s actually taking care of them and those who aren’t.

All in all, I understand where you are coming from. But it is up to the new doctors to change that stigma. It is saddening how easy it is for doctors to get too comfortable, copy paste documentation, and hardly look at the patient.
 
Futmedlat said:
It is saddening how easy it is for doctors to get too comfortable, copy paste documentation, and hardly look at the patient.
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Yes, this happens because all the bad doctors are "too comfortable"

I'm sorry your cousin had a bad time. Not sure it proves anything tho
 
Great, now I can't even vent on here without families chasing us here.

cant judge your cousins case without knowing the actual timeline of events but 1) the ob may have addressed the problems in a timely fashion per standard of care i.e. "next day" as you yourself said , be aware patients and families have a wildly different expectation of what is timely compared to actual standard of care

and

2) this is a forum for hospitalists. we dont typically see young healthy highly functional patients, and when we do , i know we work 110% the extra mile for them because bad outcomes are not tolerable for them. this thread is mostly about the unrealistic expectations people have for their loved ones who were born in the Great Depression and how they abuse everyone around them to get their way
 
I’m not chasing you. And please don’t take this personal. I don’t think most doctors are like this. I would like to believe the great majority aren’t. I am just putting myself on the family’s side for a second here, and just pointing out where their mistrust might come from. It is not fair to you, specially if you re one of the good ones, but sometimes families simply don’t know any better, and they have fear from prior past experiences.

I honestly don’t even know how I landed on this thread. My cousin’s issue is pretty recent, she is still admitted but improving. I don’t see the need to get into the details, but other doctors have agreed that the way his person handled the situation was actually not the standard of care at all.

For what is worth, I actually wished many times she was under the care of a hospitalist and not under the obstetrician care. We re lucky he consulted infectious disease, who took over her case alongside the general surgery team. But it did take almost 48 hours of her worsening to get there.

All you are saying is completely valid, but family mistrust does have roots somewhere.
 
Futmedlat said:
I’m not chasing you. And please don’t take this personal. I don’t think most doctors are like this. I would like to believe the great majority aren’t. I am just putting myself on the family’s side for a second here, and just pointing out where their mistrust might come from. It is not fair to you, specially if you re one of the good ones, but sometimes families simply don’t know any better, and they have fear from prior past experiences.

I honestly don’t even know how I landed on this thread. My cousin’s issue is pretty recent, she is still admitted but improving. I don’t see the need to get into the details, but other doctors have agreed that the way his person handled the situation was actually not the standard of care at all.

For what is worth, I actually wished many times she was under the care of a hospitalist and not under the obstetrician care. We re lucky he consulted infectious disease, who took over her case alongside the general surgery team. But it did take almost 48 hours of her worsening to get there.

All you are saying is completely valid, but family mistrust does have roots somewhere.
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Didn't realize this was so recent for you guys, sorry you're going through this.
 
for those venting about families having chart access or whatever. wait until you have a loved one or parent who is ill. you will be 100% grateful for having chart and lab access, it makes the world of difference. once you have had a loved one who is seriously ill and in the hospital, you see things in a different light. i know it did for me, and I think i'm a better physician for it.
 
glorifiedresident said:
for those venting about families having chart access or whatever. wait until you have a loved one or parent who is ill. you will be 100% grateful for having chart and lab access, it makes the world of difference. once you have had a loved one who is seriously ill and in the hospital, you see things in a different light. i know it did for me, and I think i'm a better physician for it.
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I have the 10 years of study and training to understand that access, there is such a massive difference it is not even in the same ballpark.
 
HemeOncHopeful19 said:
I have the 10 years of study and training to understand that access, there is such a massive difference it is not even in the same ballpark.
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I never said there wasn't a difference, but when you are faced with the situation you can understand the importance of having access to the information.
 
glorifiedresident said:
for those venting about families having chart access or whatever. wait until you have a loved one or parent who is ill. you will be 100% grateful for having chart and lab access, it makes the world of difference. once you have had a loved one who is seriously ill and in the hospital, you see things in a different light. i know it did for me, and I think i'm a better physician for it.
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I don't mind generally, but I'd love at least a 24 hour wait before its released to them. I get quite irritated when I get Mychart messages about labs before I've even looked at them. NB: I address labs within 24 hours 99.9% of the time so its not like they're waiting 2 weeks.
 
MD46 said:
Hopkins Charges for mychart messages, i think it is $25-50 a message, they started about 2 years ago I believe. From some people I have spoken to, their mychart message burden has significantly decreased.
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Patients need to have more skin in the game. This applies not just to my chart messages but in general. As mentioned above, if they choose to ignore evidence based medical advice wrt taking medications, exercise, diet, screening exams we shouldn’t be the only ones penalized (quality metrics that affect our income).
 
MD46 said:
Hopkins Charges for mychart messages, i think it is $25-50 a message, they started about 2 years ago I believe. From some people I have spoken to, their mychart message burden has significantly decreased.
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Makes sense. Why should we work for free.
Lawyers bill in 6 minute increments for literally everything.
 
MD46 said:
Hopkins Charges for mychart messages, i think it is $25-50 a message, they started about 2 years ago I believe. From some people I have spoken to, their mychart message burden has significantly decreased.
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Are there any other institutions that do this? We should have a running list.
 
MifflinDunder said:
Are there any other institutions that do this? We should have a running list.
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Many do. But it's not as simple as "MyChart messages cost $25 to send". There are time requirements for billing MyChart messages and you have to get consent to do it. So, as I, and many, have mentioned before, any MyChart message that takes me longer to respond to than this question did gets an appointment scheduled at my convenience.
 
Per Hopkins website for patients:
When you initiate sending a message and select “Ask a medical question,” a pop-up notification will automatically display in MyChart. You can choose one of the following options in response:

  • If you agree to the terms in the pop-up, select “Next” and continue with your non-urgent MyChart message. If the clinician bills for their medical advice, it will appear in the “Visits” section of MyChart as an “eVisit,” with an after-visit summary just as it would for a video or in-person visit.
  • Otherwise, decline and exit the messaging field. You can schedule an appointment if you prefer to have your question answered through an in-person or video visit.
How much will I be billed for medical advice through MyChart messages?
Most MyChart messages are free. Clinicians may only bill for messages that require at least five minutes of time spent reviewing the medical record and providing medical advice. If you do not have insurance, out-of-pocket costs will range from approximately $15–$50, depending on the amount of time spent by your clinician. For most insurance plans, if your message is billed, you may not be charged at all or you may see a low out-of-pocket cost.


So basically regardless of patient getting charged or not, you can get paid for it.
If they keep on sending messages and its covered by their insurance, at least this way you can bill
I agree with GutOnc, anything more than a 5 min review definitely warrants a visit.
 
MD46 said:
Per Hopkins website for patients:
When you initiate sending a message and select “Ask a medical question,” a pop-up notification will automatically display in MyChart. You can choose one of the following options in response:

  • If you agree to the terms in the pop-up, select “Next” and continue with your non-urgent MyChart message. If the clinician bills for their medical advice, it will appear in the “Visits” section of MyChart as an “eVisit,” with an after-visit summary just as it would for a video or in-person visit.
  • Otherwise, decline and exit the messaging field. You can schedule an appointment if you prefer to have your question answered through an in-person or video visit.
How much will I be billed for medical advice through MyChart messages?
Most MyChart messages are free. Clinicians may only bill for messages that require at least five minutes of time spent reviewing the medical record and providing medical advice. If you do not have insurance, out-of-pocket costs will range from approximately $15–$50, depending on the amount of time spent by your clinician. For most insurance plans, if your message is billed, you may not be charged at all or you may see a low out-of-pocket cost.


So basically regardless of patient getting charged or not, you can get paid for it.
If they keep on sending messages and its covered by their insurance, at least this way you can bill
I agree with GutOnc, anything more than a 5 min review definitely warrants a visit.
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I can count on 1 hand the number of MyChart messages I have spent 5 min or more on in the last 14+ years of practice. You get 2 or 3 lines, and after that, you're coming in.
 
Once upon a time my group got a scathing Google review about not having MyChart from a patient who claimed it was illegal as we were “restricting their access” despite having spoken to them promptly over the phone and printed their entire record on request.

That contributed to us never considering anything similar to it as we would be getting even more calls about “what does this thing mean?”
 
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